2010-03-09 Facts about GAMC Compromise Agreement GAMC Facts The following is a summary of the agreement reached on GAMC. This explains the various funding mechanisms and care techniques being utilized under the new GAMC. Coordinated Care Organizations (CCOs) Accountable Care Organizations (ACOs) and Medical Homes are terms for a care model we are moving toward for this patient population. Despite technical differences, people use these terms interchangeably. Basically it is a way to connect unconnected providers to make sure people are getting care that gets them back on their feet instead of racking up revenue. The agreement reached stops auto enrollment for two additional months. In that time period, 17 hospitals set up coordinated care systems. In agreeing to this, hospitals assume the cost of caring for GAMC patients for an intensive coordinated care delivery model for six months. They will have the incentive to find the most appropriate program (VA, MA, MNCare etc) the patient qualifies for and get them there quickly. Hospitals will have a disincentive to admit patients, and an incentive to keep them on their medications and get them healthy and stable. There is a pool of money for the patients as well as the medicines. For all other hospitals, there is a $20M pool set up for these to bill into for the remainder of the year. Reimbursement will be based on GAMC eligible claims. It is the intent that these hospitals will become CCOs or form agreements with others within existing systems in the next year. Extending the 2nd tier pool would require legislative action in the next biennium. The expenditure for the CCOs is capped at $110M/year in the next biennium. DHS is getting us more data on costs and comparisons to other proposals. The agreement is a solution aimed at capping spending, directing dollars to the areas of most need, transitioning patients to the most appropriate healthcare program and finally to get these folks healthy and productive again. Below is the text of the Actual Agreement signed by Senators Berglin and Senjem, Representatives Huntley and Dean and Department of Human Services Commissioner Cal Ludeman. 1. We agree to stop auto-enrollment 2. Agree to 2-month bridge via GAMC at a one-time HCAF cost of $28 million. 3. Propose $71 million for CCOs. This covers a 130month period in FY 2010-11. The appropriation for this program is capped and on-going. The FY 2012-13 amoutn budgeted for this program is $131 million. 4. Agree to 10% increase going to 3 CCO hospitals; Hennepin County Medical Center (HCMC), Regions and University of Minnesota-Fairview. 5. We agree to the concept of a drug pool. Propose $45 million for drug pool. This covers a 13-month period in FY 2010-11. The appropriation for this program is capped and on-going. The FY 2012-13 amount budgeted for this program is $83 million. 6. Agree to CCO match to state for drug pool of 20%. 7. Agree to Temporary UCP at a on-time HCAF cost of $20 million. 8. No reductions to CCSA grants or DHS administration to finance cost of proposal. Subsequent fiscal analysis by staff to determine available savings from DSH, recoveries, drug rebates. 9. No extraneous language in the bill that doesn’t relate directly to this proposal. 10. Total
FY 2010-11 cost for this Proposal: Bridge via GAMC = $28M Health Care Access Fund (HCAF) CCOs = $71M General Fund (GF) Drug Pool = $45M GF Temporary UCP = $20M HCAF $164
million in FY 2010-11 Bridge via GAMC = $0 Health Care Access Fund (HCAF) CCOs = $131M General Fund (GF) Drug Pool = $83M GF Temporary UCP = $0 HCAF $214
million in FY 2010-11 |
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